Scientific Review of Physical Culture, volume 5, issue 4
EFFECTS OF A 12-WEEK MULTIMODAL EXERCISE PROGRAM ON
FUNCTIONAL FITNESS OF OLDER ADULTS
Róbert KANDRÁČ, Lenka TLUČÁKOVÁ, Pavol ČECH
Faculty of Sports, University of Prešov, Prešov, Slovakia
Keywords:
 performance



capacity,
late life,
physical activity,
movement.
Abstract:
The purpose of the present study was to determine the effect of a 12week multimodal exercise program on functional fitness parameters
of older adults. A sample of 21 elderly women aged 61.67 ± 2.92
years living in the city of Presov performed Senior Fitness Test
designed to assess lower- and upper-body strength, aerobic
endurance, lower- and upper-body flexibility, agility and dynamic
balance. The elderly women participated in the exercise program
ProSenior over 12 weeks. The program consisted of two exercise
sessions performed in the morning hours. Participation in a 3-month
exercise program exerted positive effect on all examined parameters
of functional fitness. The frequency of one exercise session at higher
exercise intensity combined with minimally one aerobic activity
seems to be sufficient to affect lower- and upper-body strength.
INTRODUCTION
The population curve is changing all over the world including Slovakia. More people
reach higher average life expectancy and the number of elderly people is increasing. Slovak
women live longer compared to their male counterparts. However, women live in bad health
[27]. Over the last few years, we have come across the term successful aging, which refers to
physiological and psychological characteristics of and individual rather than population
average [14]. Most of aging-associated factors may be positively affected by regular exercise
[3, 4, 7, 8, 12, 23, 26, 28]. Among important terms used in the field of physical activity and
inactivity of older people is the term ‘functional fitness’, which includes components such as
lower and upper body muscle strength, lower and upper body flexibility, aerobic endurance,
motor agility/dynamic balance, and body-mass index [26]. Physical training is important in
delaying the crossing of the threshold to physical dependence. It provides the individual with
the power to positively influence their own health and functional abilities as they age [23].
Bates et al. in their pilot study confirm positive changes in functional fitness through special
strength training applied once weekly [3]. Small gains in health, or even a reduction in the
rate of decline in functional capacity, can make a tremendous difference in older adults’
quality of life by preserving their ability to execute activities of daily living [16].
The issue of successful aging in elderly population is becoming topical especially with
regard to positive effect on social functioning. We assume that aging does not have to be
a negative process, but positive experience.
THE AIM OF THE WORK
The aim of the present study was to determine the effect of a 12-week multimodal
exercise program on functional fitness parameters of older adults.
35
Scientific Review of Physical Culture, volume 5, issue 4
THE MATERIAL AND THE METHODOLOGY
The experimental group of physically active elderly women (EG) was created using the
snowball sampling technique. The EG consisted of 21 elderly women aged 61.67 ± 2.92 years
living in the city of Presov.
The elderly women participated in the exercise program ProSenior over 12 weeks
(February 2008 – May 2008). The program consisted of two exercise sessions performed in
the morning hours (9 a.m.). The design of the exercise program adhered to the
recommendations of the American Council on Exercise [2], American College of Sports
Medicine [1] and American Heart Association [18]. We attempted to design a multimodal
exercise program by implementing resistance exercise: circuit training performed on
resistance machines, body weight exercises and free-weight exercises, aerobic exercise:
aerobics, tae-bo, Latin-American dancing and flexibility exercise: stretching exercises in the
warm-up and cool-down part of the exercise session and spinal exercises. The exercise
program did not include exercise for coordination development as we hypothesized positive
synergic effect of resistance, aerobic and flexibility exercise on motor coordination.
Functional fitness was measured using the Senior Fitness Test – SFT [20] designed to
assess lower- and upper-body strength, aerobic endurance, lower- and upper-body flexibility,
agility and dynamic balance.
The collected data were processed using the Shapir-Wilk test in order to evaluate data
distribution. To determine the changes in particular parameters, paired samples T-test was
used. The statistical significance was set at p<.05. The procession and evaluation of data was
carried out using the statistical software SPSS 16.0.
RESULTS AND DISCUSSION
The average baseline test scores in tests T2, T3 and T5 were classified as aboveaverage. However, the baseline test scores in tests T1, T4 and T6 were categorized as average.
Three-month exercise resulted in improved T1 test scores, which changed to above-average.
The pre-testing and post-testing BMI index values showed the elderly participants were
overweight (see Table 1).
Table 1. Pre- and post-testing level of functional fitness parameters and their comparison with
normative scores for American population
N
Minimum
Maximum
M
T1
SD
Assessment
I
21
10
21
15.29
2.98
Normal
II 21
11
28
20.29
3.60
Above normal
T2
I
21
16
25
19.67
2.57
Above normal
II 21
19
32
24.52
3.20
Above normal
T3
I
21
89
154
121.71
19.49
Above normal
II 21
86
163
126.19
20.25
Above normal
T4
I
21
-3.5
9.5
4.25
3.32
Normal
II 21
-2.0
9.1
4.68
2.73
Normal
T5
I
21
-2.2
4.9
1.95
1.44
Above normal
II 21
-2.4
5.1
2.18
1.68
Above normal
T6
I
21
4.2
5.9
4.83
.51
Normal
II 21
3.5
6.0
4.72
.52
Normal
BMI index
I
21
21.2
35.2
28.10
4.47
Overweight
II 21
20.8
36.2
27.88
4.36
Overweight
Age
I
21
58
69
61.67
2.92
Note. N - number of participants, M - arithmetic mean, SD - standard deviation, T1 - Test of lower-body strength, T2 - Test of
upper-body strength, T3 - 2-minute step test, T4 - Test of lower-body flexibility, T5 - Test of upper-body flexibility, T6 Test of dynamic balance and agility, I – pre-testing, II – post-testing after 3 months of exercise
36
Scientific Review of Physical Culture, volume 5, issue 4
Table 2. Changes in the level of functional fitness parameters
T1I - T1II
T2I - T2II
T3I - T3II
T4I - T4II
T5I - T5II
T6I - T6II
BMII - BMIII
M
SD
t
df
p
-5.000
-4.857
-4.476
-.4286
-.2238
.1048
.2238
2.683
2.175
19.916
1.9784
1.0202
.3956
.7949
-8.539
-10.236
-1.030
-.993
-1.005
1.214
1.290
20
20
20
20
20
20
20
.000**
.000**
.315
.333
.327
.239
.212
Note. M - arithmetic mean, SD - standard deviation, t - t value, df - degrees of freedom, ** - level of statistical significance
p<.01, I – pre-testing, II – post-testing, T1 - lower-body strength, T2 - upper-body strength, T3 - 2-minute step test, T4 lower-body flexibility, T5 - upper-body flexibility, T6 - Dynamic balance and agility, BMI - BMI index
Following 3 months of exercise, there were positive changes in lower- and upper-body
strength, aerobic endurance, lower- and upper-body flexibility and dynamic balance.
Statistically significant difference between baseline and outcome measures was found only in
lower- and upper-body strength (see Table 2).
Three-month multimodal exercise improved lower- and upper-body strength. The
positive effect of exercise on lower- and upper-body strength was observed in all participants
(see Figure 1 and 2). The lower-body strength improved 32.7% and upper-body strength
24.7%.
Number of stands
30
25
20
15
10
&kjkji
5
0
1 2
3
4 5
6 7
8 9 10 11 12 13 14 15 16 17 18 19 20 21
Participant
Baseline measurement
Outcome measurement (3 months)
Figure 1. Chair Stand Test
After three months of exercise, there was improvement in aerobic endurance, however,
not statistically significant (see Table 2). The improvement yielded 3.7%. We assume this was
influenced especially by exercise frequency (1 exercise session per week) and intensity of
aerobic exercise (11th - 12th degree on the Borg exertion scale, which equals 60-65% of
physical exertion.
There were statistically insignificant improvements in lower- and upper-body flexibility
after 3-month exercise. Overall, lower-body strength improved 10 % and upper-body strength
11.4%. This finding is not surprising because the volume of exercise performed for flexibility
development: (1) stretching exercise maintaining maximal stretch for 10-15 seconds two or
three times and (2) spinal exercises (10 repetitions) with transition to maximal stretch applied
at the beginning and at the end of the exercise session amounting to total time of 10-15
37
Scientific Review of Physical Culture, volume 5, issue 4
minutes is considered minimal for maintaining and developing flexibility in elderly people
according to ACSM and AHA [18].
Number of curls
35
30
25
20
15
10
5
0
1 2
3
4 5
6
7 8
9 10 11 12 13 14 15 16 17 18 19 20 21
Participant
Baseline measurement
Outcome measurement (3 months)
Figure 2. Arm Curl Test
Number of steps
The improvements in dynamic balance following 3 months of exercise were not
statistically significant, when the improvement equaled 2.2%. There was significant
improvement in 11 participants and moderate decrease in 10 participants (see Figure 6). It
should be noted that test score averages in baseline and post-test measurements were
classified as average.
Although BMI is not a direct measure fatness, and it is not sensitive to redistributions of
fat, it can be used as a proxy for relative fatness and is a more accurate measure of total body
fat than weight alone [24]. The BMI changed after 3 month of exercise. The initial values
were classified participants in the overweight category. At baseline, 6 participants
demonstrated normal weight, 7 participants were overweight, 7 participant showed 1st degree
obesity and 1 participant 2nd degree obesity. At outcome measurements, 5 seniors
demonstrated normal weight, 8 participants were overweight, 7 participants demonstrated 1st
degree obesity and 1 participant showed 2nd degree obesity.
180
160
140
120
100
80
60
40
20
0
1 2 3
4 5 6 7
8 9 10 11 12 13 14 15 16 17 18 19 20 21
Participant
Baseline measurement
Outcome measurement (3 months)
Figure 3. 2-Minute Step test
38
Scientific Review of Physical Culture, volume 5, issue 4
10
8
Inches
6
4
2
0
-2
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
-4
Participant
Baseline measurement
Outcome measurement (3 months)
Figure 4. Chair Sit-And-Reach Test
Consistently with the results of previous studies, 3-month exercise improved lower- and
upper-body strength. We hypothesize that this improvement was the result of the complex
effect of resistance and aerobic exercise, which involved large muscle groups. Fahlman et al.
reported that multimodal and resistance programs exerted similar effects on strength and
functional abilities in elderly people. The most effective exercise frequency in women is
exercising twice per week, which may be associated with longer recovery period following
exercise [11]. DiFrancisco-Donoghue [10] reported that participation in exercise once per
week equaled exercise participation twice per week.
The multimodal exercise program did not exert statistically significant effect on aerobic
endurance. We may assume that higher intensity of aerobic exercise (13th – 16th degree of
the Borg scale equaling 70-85% of physical exertion recommended by ACSM and AHA [18]
would probably have increased the effectiveness of exercise. This finding is consistent with
the investigation of Swoap et al. [25], who monitored the effect of exercise intensity on
aerobic endurance in elderly people. Over 26 weeks, two groups of participants perfomed two
types of exercise at different intensities (80-85% or 65-70%). The participants who performed
exercise at higher intensity reported greater changes in aerobic capacity compared to their
counterparts performing lower-intensity exercise. Shepard reported that the magnitude of
response to aerobic exercise depends on training and on the individual level of aerobic fitness.
However, he also stated that the effect of higher-intensity exercise did not differ from that
with higher volume of exercise [22].
Inches
10
8
6
4
2
0
-2
-4
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Participants
Baseline measurement
Outcome measurement (3 months)
Figure 5. Back Scratch Test
39
21
Scientific Review of Physical Culture, volume 5, issue 4
7
Seconds
6
5
4
3
2
1
0
1
2
3
4
5
6
7
8
9 10 11 12 13 14 15 16 17 18 19 20 21
Participants
Baseline measurement
Outcome measurement (3 months)
Figure 6. Foot Up-And-Go Test
We assume that achieving greater improvements in flexibility requires increase in
exercise frequency at the rate of 5 times per week. Therefore, we advised the participants to
performs flexibility exercise at home, which was welcome by some participants who carried
out flexbility exercise prior to the commencement of the exercise program (n = 9). Most of
the participants failed to perform these exercises due to lack of time or due to preference of
group exercise. The participants realized the benefits of home-based exercise, however with
little effect. The exercise program motivated them to participate in organized exercise twice
a week excluding the effect of home-based exercise. Flexibility together with muscular
strength and endurance (so-called muscular fitness) is required for the execution of most
activities of daily living [19]. Decrease in flexibility leads to the origination of health
problems, reduction in basic and instrumental activities of daily living and the progression of
disabilities [8, 9, 13, 17]. Due to the reasons mentioned, the applied exercise program resulted
in little improvements in flexibility.
40
35
Index
30
25
20
15
10
5
0
1 2
3
4 5
6
7 8
9 10 11 12 13 14 15 16 17 18 19 20 21
Participant
Baseline measurement
Outcome measurement (3 months)
Figure 7. Body Mass Index
Insignificant improvements in dynamic balance and agility may have resulted from not
implementing specific balance exercises into the exercise program. We hypothesized that the
effect of aerobic exercise (aerobics, tae-bo and Latin-American dancing), resistance and
40
Scientific Review of Physical Culture, volume 5, issue 4
flexibility exercise would considerably affect its level. As reported by Rogers et al. [21],
balance depends on the sensory input and organization, muscular strength, coordination of
activity, level of attention, disease and medications. The decrease in at least one of these
factors leads to negative balance scores. Physical activity may eliminate several negative
factors by preventing falls, so frequent in elderly people.
The finding that exercise program did not significantly change the BMI scores in
participants who were overweight or obese was not surprising. This may be attributed to low
frequency and medium intensity of exercise frequency. Those participants who wanted to
reduce their weight were advised to increase the volume of aerobic exercise outside the
exercise program. Jurkovičová [15] concluded that prevention is the most effective tool for
fighting overweight and obesity. This should become priority of public health care, whose
main pillar should be the change in one's lifestyle through change in eating habits and
increase in the volume of physical activity. The issue of obesity in elderly women has been
researched by Bortz and Singh [5] who concluded that obesity-inducing factors in elderly
people differ and include genetic and environmental effects. The storage of redundant energy
in adipose tissue may occur only if energy intake chronically overweighs energy output.
Besides long-term aerobic activity and adjustment of eating habits is resistance training an
important tool for fighting obesity. Resistance training improves the regional fat tissue
disposition (even in unchanged weight) and considerably increases the resting energy output
compared to aerobic training.
CONCLUSIONS
The present study extends evidence related to positive effects of physical activity on the
parameters of functional fitness in elderly women. Participation in a 3-month exercise
program exerted positive effect on all examined variables. The frequency of one exercise
session at higher exercise intensity combined with minimally one aerobic activity seems to be
sufficient to affect lower- and upper-body strength.
Therefore, we recommend implementation of various forms of aerobic activity into
exercise programs in order to both activate various muscle groups and to motivate participants
to exercise. Stereotypical exercise may, after some time, become demotivating and may lead
to dropping out of the exercise program. Therefore, it would be appropriate to organize
seminars and lectures on different topics related to every-day life, aging process, healthy
eating habits, home-based exercise, handling stressful situations and communication.
We consider the Senior fitness test an appropriate diagnostic tool of motor abilities in
elderly women with designing norms for Slovak population, through which the Senior Fitness
Test would become an applicable diagnostic tool in Slovakia as well.
From the social aspect, it would be appropriate to support and create conditions for
participation in regular exercise and organized physical activity for elderly people due to the
fact that positive benefits for society through improvement in overall physical and mental
functioning of senior citizens is unquestionable.
REFERENCES
1. American College Of Sports Medicine. (1998) ‘Position statement: The recommended
quantity and quality of exercise for developing and maintaining cardio respiratory and
muscular fitness an healthy adults’, Medicine and Science in Sports and Exercise, 30 (6),
pp. 975-991.
2. American Council On Exercise. (1998) Exercise for older adults. Champaign-Urbana, IL:
Human Kinetics.
3. Bates, A., Donaldson, A., Lloyd, B., Castell, S., Krolik, P. and Coleman, R. (2009)
‘Staying active, staying strong: pilot evaluation of a once-weekly, community-based
41
Scientific Review of Physical Culture, volume 5, issue 4
strength training program for older adults’, Health Promotion Journal of Australia, 20 (1),
pp. 42-47.
4. Bocalini, D. S., Serra, A. J. and Dos Santos, L. (2010) ‘Moderate resistive training
maintains bone mineral density and improves functional fitness in postemenopausal
women’, Journal of Aging Research, 2010 (4).
5. Bortz, S. and Singh, F. M. A. (2004) Exercise, nutrition, and the older woman. Wellness
for Women Over Fifty. London: CRC Press.
6. Buckwalter, J. (1997) ‘Decreased mobility in the elderly: The exercise antidote’,
Physician and Sports Medicine, 2 (9), pp. 127-133.
7. Carvalho, M. J., Marques, E. and Mota, J. (2009) ‘Training and detraining effects on
functional fitness after a multicomponent training in older women’, Gerontology, 55 (1),
pp. 41-48.
8. Cavani, V., Mier, C. M., Musto, A. A and Tummers, N. (2002) ‘Effects of 6-week
resistance training program on functional fitness of older adults’, Journal of Aging and
Physical Activity, 10 (4), pp. 443-452.
9. DiBrezzo, R., Shadden, B. B., Raybon, B. H. and Powers, M. (2005) ‘Exercise
intervention designed to improve strength and dynamic balance among communitydwelling older adults’, Journal of Aging and Physical Activity, 13 (2), pp. 198-209.
10. DiFrancisco-Donoghue, J., Werner, W. and Douris, P. C. (2007) ‘Comparison of onceweekly and twice-weekly strength training in older adults’, British Journal of Sports
Medicine, 41 (1), pp. 19-22.
11. Fahlman, M. M., Morgan, A., McNevin, N., Topp, R. and Boardley, D. (2007)
‘Combination training and resistance training as effective interventions to improve
functioning in elders’, Journal of Aging and Physical Activity, 15 (2), pp. 195-205.
12. Hallage, T., Krause, M. P., Haile, L., Miculis, C. P., Reis, R. S. and Da Silva, S. G. (2010)
‘The effects of 12 weeks of step aerobics training on functional fitness of elderly women’,
Journal of Strength and Conditioning Research, 24(8), pp. 2261-2266.
13. Holland, G. J., Tanaka, K., Shigematsu, R. and Nakagaichi, M. (2002) ‘Flexibility and
physical functions of older adults: a review’, Journal of Aging and Physical Activity, 10
(2), pp. 169-206.
14. Jones, J. C. and Rose, D. J. (2005) Physical activity instruction of older adults.
Champaign-Urbana, IL: Human Kinetics.
15. Jurkovičová, J. (2005) Vieme zdravo žiť? Zdravotný stav slovenskej populácie a prevencia
kardiovaskulárnych a civilizačných ochorení. Bratislava: Lekárska Fakulta UK.
16. McAuley, E., Konopack, J. F., Motl, R. W., Morris, K. S., Doerksen, S. E. and Rosengren,
K. R. (2006) ‘Physical activity and quality of life in older adults: Influence of health status
and self-efficacy’, Annals of Behavioral Medicine, 1 (1), pp. 99-103.
17. Milton, D., Porcari, J. P., Foster, C., Gibson, M., Undermann, B., Greany, J. and Murray,
S. R. (2008) ‘The effect of functional exercise training on functional fitness levels of older
adults’, Gundersen Lutheran Medical Journal, 5 (1), pp. 4-8.
18. Nelson, M. E., Rejeski, W. J., Blair, S. N., Duncan, P. W., Judge, J. O., King, A. C.,
Macera, C. A. and Castaneda-Sceppa, C. (2007) ‘Physical activity and public health in
older adults: recommendation from the American College of Sports Medicine and the
American Heart Association’, Medicine and Science in Sports and Exercise, 39 (8), pp.
1435-1445.
19. Phillips, W. T. and Haskell, W. L. (1995) ‘Muscular fitness - Easing the burden of
disability for elderly adults’. Journal of Aging and Physical Activity, 3 (3), pp. 261-289.
20. Rikli, R. E. and Jones, J. C. (2001) Senior Fitness Test Manual. Champaign-Urbana, IL:
Human Kinetics.
42
Scientific Review of Physical Culture, volume 5, issue 4
21. Rogers, M. E., Rogers, N. L. and Takeshima, N. (2005). ‘Balance training in older adults’,
Aging Health, 1 (3), pp. 475-486.
22. Shepard, R. J. (2006) ‘Exercise dose-response effects in older adults’. In Zhu, W. and
Chodzko-Zajko, W. (eds.) Measurement Issues in Aging and Physical Activity.
Champaign-Urbana, IL: Human Kinetics, pp. 23-34.
23. Sierpowska, A., Ciechanowicz, I. and Cywińska-Wasilewska, G. (2006) ‘Functional
fitness assessment among elderly women (60+) participating in yoga or swimming
exercises’. Studies in Physical Culture and Tourism, 13 (Suppl.), pp. 81-83.
24. Spirduso, W. W., Francis, K. L. and MacRae, P. G. (2005) Physical dimensions of aging.
Champaign-Urbana, IL: Human Kinetics.
25. Swoap, R. A., Norvell, N., Graves, J. E. and Pollock, M. L. (1994) ‘High versus moderate
intensity aerobic exercise in older adults: psychological and physiological effects’,
Journal of Aging and Physical Activity, 2 (4), pp. 293-303.
26. Toraman, N. F., Erman, A. and Agyar, E. (2004) ‘Effect of multicomponent training on
functional fitness in older adults’, Journal of Aging and Physical Activity, 12 (4), pp. 538553.
27. Vaňo, B., Jurčová, D., Mészáros, J., Potančoková, M. and Šprocha, B. 2007. Populačný
vývoj v Slovenskej republike 2006. Bratislava: Infostat, 2007.
28. Wilkin, L. D. and Haddock, B. L. (2010) ‘Health-related and functional fitness among
older adults’. International Journal of Aging and Human Development, 70 (2), pp. 107118.
43